Vitiligo Support GroupJanuary 13, 2015

Seemal R. Desai, MD, FAADClinical Assistant Professor

Dept of Dermatology

Innovative DermatologyPlano, TX

www.innovative-dermatology.com

Phototherapy

• Phototherapy or Light Therapy is a service billed to insurance with one of these codes.– 96910 code for Narrowband UVB treatment– 96920/96921/96922 codes for Excimer laser treatment

• Medicare/Medicaid track and make payments based on the above codes• Payment for NB-UVB increased over the past 15 years, except 2013-2014• In 2013, payment was decreased by 9.26%, mainly due to allocation of

funds that are no longer part of the Practice Expense, by CMS (Centers for Medicare & Medicaid Services) for non-physician staff

• Due to the payment decrease, Phototherapy is under threat, and…therefore treatment for patients suffering from vitiligo

Insurance Coverage for Phototherapy and Excimer in Texas

Phototherapy ExcimerBCBS

YESBCBS

NO

Cigna YES

Cigna NO

United Healthcare YES

United Healthcare YES

Aetna YES

Aetna YES

Medicare NO

Medicare NO

**Your dermatologist may need to write a Letter of Medical Necessity

Topical Therapies

• Some drugs and topical creams still gets denied from insurance coverage, especially when topical steroids have not been tried.

• Topical Steroids used to cost less earlier– Clobetasol ointment 60gram costs $315.00 now, used to be

approximately $30 for same quantity– GoodRx (http://www.goodrx.com/) is a great source to check

pharmacy prices for medicines in your zip code• No price regulation of generic manufacturers, so prices could rise,

and many dermatologists now prescribe brand names as a result.

What can you do?

• Write to our elected officials and express to them your concern about cuts to Medicare and the SGR(Sustainable Growth Rate)– Use your own example of vitiligo, but needs to be a

“global” appeal• Texas Rep Burgess in Denton helped spearhead reform